Suspected Sacral Stress Fracture or Bone Injury Not Seen on X-ray: When MRI Is Needed

FAQ: Suspected Sacral Stress Fracture or Bone Injury Not Seen on X-ray

Can sacral or tailbone fractures be missed on X-ray?

Yes. Stress fractures, hairline fractures, and bone marrow injuries of the sacrum or coccyx are commonly missed on plain X-rays. Early or subtle bone injuries may not cause visible structural changes on X-ray despite significant pain.

What situations raise suspicion of a hidden sacral fracture?

MRI should be considered if:

• Pain persists despite a “normal” X-ray
• Pain worsens with weight-bearing, standing, or sitting
• There is focal tenderness over the sacrum or tailbone
• Pain developed after repetitive strain, increased activity, or minor trauma

These scenarios are common in individuals who exercise, walk long distances, or have recently increased physical activity.

Why does pain persist if X-rays are normal?

X-rays show bone alignment and gross fractures but do not detect bone marrow oedema, stress reactions, or early fractures. These injuries can still cause significant pain and functional limitation if left undiagnosed.

Why is MRI the preferred test in this situation?

MRI is one of the most accurate imaging modalities currently available.
Without accurate imaging, no doctor—regardless of experience—can reliably make a precise diagnosis.
Without accurate diagnosis, treatment plans become generic, presumptive, and often fail.
Many failed treatments are due to trial-and-error care without imaging.

MRI allows doctors to detect:

• Sacral stress fractures
• Bone marrow oedema
• Occult fractures not seen on X-ray
• Healing status of bone injuries

Based on modern medical technology and current standard of care, MRI should be considered in this scenario.
MRI is safe and does NOT involve ionising radiation.

Isn’t MRI expensive if X-rays are already done?

Cost concerns are common. However, repeated clinic visits, prolonged pain, and ineffective treatments often cost more in the long term. MRI helps avoid delayed diagnosis and unnecessary trial-based care.

Why do MRI appointments take so long elsewhere?

Long waiting times are common due to high demand and limited access. Delays can prolong uncertainty and pain, especially when mobility or sitting tolerance is affected.

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Why Consider MRI at The Pain Relief Clinic?

The Pain Relief Clinic is centrally located at 350 Orchard Road, Shaw House, just a 5-minute walk from Orchard MRT, with convenient parking and immediately outside ERP.

Key benefits include:

• MRI machine on-site
• Doctor can assess and directly arrange MRI immediately
• No need to visit a separate imaging centre
• No need to find another doctor just for an MRI referral
• Doctor has been helping patients with spine and joint problems since 2007 (18 years)
• Focus on non-invasive, technology-powered treatments

MRI arrangements aim to be:

• Under $1000
• Within 1 working day

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Can Insurance or Medisave Help Cover MRI?

MRI scans may be covered by:

• Personal accident insurance
• Travel insurance
• Company insurance
• Company flexi-benefits
• Hospitalisation plans (policy-dependent)
• Medisave

Medisave limits:

• Current: $300
• From 1 Jan 2026: $600

Medisave can potentially cover more than half the MRI cost, depending on policy eligibility.

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Key Takeaway

If sacral or tailbone pain persists despite normal X-rays, a hidden bone injury should be considered. MRI provides the clarity needed to guide appropriate care and avoid prolonged discomfort.

For more information or to arrange an MRI scan, contact The Pain Relief Clinic via WhatsApp at +65 9068 9605.